Republican rep wants to return Medicaid expansion authority to governor

This story has been republished with permission from Tennessee Lookout. Read the original story here.

Outgoing Republican Rep. Sam Whitson is mulling a reversal of state law requiring the governor to gain approval from the Legislature before expanding Medicaid.

Whitson, a Franklin lawmaker who recently announced he will not seek re-election in 2024, said Tuesday he’s been considering such a measure for two years with Tennessee forgoing billions in federal funding that could enable the working poor to obtain insurance coverage. He has not filed a bill yet.

The amount Tennessee is losing ballooned from about $1 billion in 2014 to $2.1 billion this year, according to healthinsurance.org.

“We should give the governor the opportunity to explore options,” Whitson told the Tennessee Lookout. “I’m not saying we need to do Medicaid expansion. I just think that was a restrictive bill done for purely political reasons to enhance Kelsey’s and Durham’s political future.”

Former Sen. Brian Kelsey, who pleaded guilty to federal campaign finance fraud but is fighting to reverse the plea, and former Rep. Jeremy Durham, who was expelled from the House in 2016 for 22 cases of sexual misconduct, passed the resolution in 2014 requiring legislative approval of a plan that former Gov. Bill Haslam was negotiating with the federal government.

Haslam’s Insure Tennessee proposal would have expanded TennCare coverage to some 250,000 uninsured and underinsured Tennesseans, giving them the opportunity to obtain health insurance through private providers, in some cases through a small premium.

Even though the Legislature directed Haslam to come up with a plan, a Senate health committee rejected it on a 7-4 vote, stopping it from reaching the House or Senate floor.

Whitson, a member of the House Health Committee, said he is talking to colleagues to see if changing the state law has “traction.”

“We leave a lot of money on the table with that. I’m a big supporter of helping the working poor, people who work and try to make a living and are caught in that gap,” Whitson said.

Tennessee is believed to have more than 300,000 uninsured and underinsured people in a gap between TennCare and Affordable Care Act coverage.

Gov. Bill Lee has refused to take up the matter, consistently saying since his first election five years ago he believes the Affordable Care Act, through which 40 states expanded Medicaid, is “fundamentally flawed.” Since then, Tennessee has lost billions annually to other states.

Democratic Rep. Caleb Hemmer of Nashville, a House Health Committee member who penned an op-ed on the matter, pointed out 70% of Tennesseans said in a recent Vanderbilt poll they back Medicaid expansion. He favors a change in the law that restricts the governor’s ability to negotiate with the feds and set policy for Medicaid expansion.

“It’s a pathway,” Hemmer said of Whitson’s idea. “I’m a little concerned our governor wouldn’t do it even if we did pass the law, based on his prior comments.”

Studies show the state could widen coverage to 150,000 to 300,000 and save money, in addition to reducing medical bankruptcies, expanding mental health resources and preventing rural hospital closings, according to Hemmer.

He pointed out the Affordable Care Act passed “a generation ago” and “the world has moved on” to other topics. In addition, Tennessee has a federal Medicaid waiver that gives the state flexibility to use TennCare savings to provide more services.

Lawmakers such as Republican Rep. Kelly Keisling of Byrdstown, who represents one of the state’s most rural districts, back Medicaid expansion but can’t find enough support within the Republican Caucus to push it to passage.

Gaining enough votes would be difficult, mainly because Obamacare and the resulting Medicaid expansion became a national political hotpoint a decade ago. Rejection of Haslam’s plan led to yearly protests at the Capitol, but Republican lawmakers haven’t budged since then. 

House Health Committee Chairman Bryan Terry said in a short statement Tuesday “any Medicaid changes will have an impact on our budget; thus, should go through the legislative process.”

Haslam’s proposal was expected to cost the state $200 million, about 10% of the overall expense, which was to be paid by the Tennessee Hospital Association. 

Democratic Sen. Jeff Yarbro of Nashville and Democratic Rep. Larry Miller of Memphis sponsored a bill during the 2023 session removing the requirement for the Legislature to approve a governor’s decision on Medicaid expansion. It didn’t move through the House or Senate committee systems.